Provider Demographics
NPI:1174985394
Name:HACKNEY, DALE (RPH)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:HACKNEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-4347
Mailing Address - Country:US
Mailing Address - Phone:360-912-4659
Mailing Address - Fax:
Practice Address - Street 1:990 E WASHINGTON ST BLDG B
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3517
Practice Address - Country:US
Practice Address - Phone:360-683-1156
Practice Address - Fax:360-683-8532
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111081835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care